Nicholas J R Maycock

University Hospitals Coventry and Warwickshire NHS Trust

Purpose: To report the short-term outcome of intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME). Design: Retrospective noncomparative (nonrandomized, uncontrolled) interventional case series. Participants: Sixty-five eyes of 54 patients with uveitis-related CME inadequately responsive to treatment comb...

Corneal wound healing is a complex process: its mechanisms and the underlying genetic control are not fully understood. It involves the integrated actions of multiple growth factors, cytokines and proteases produced by epithelial cells, stromal keratocytes, inflammatory cells and lacrimal gland cells. Following an epithelial insult, multiple cytoki...

We discuss new approaches to the early detection of keratoconus (KCN) and recent investigations regarding the nature of its pathophysiology. We review the current evidence for its complex genetics and evaluate the presently identified genes/loci and potential candidate gene/loci. In addition, we highlight current research methodologies that may be...

http://www.ewreplay.org/content/late-stromal-rejection-deep-anterior-lamellar-keratoplasty

The new edition of this leading text atlas on corneal topography has been updated to include the latest advances in technology, such as Pentacam and Orbscan. The principles and theory underlying each technology are first clearly explained, and clinical applications are then examined. The authors describe how to use the different technologies and de...

PURPOSE: The ongoing PERSPECTIVE study aims to evaluate, in routine clinical practice, the effectiveness, tolerability and safety of cyclosporine (CsA) eye drop emulsion in controlling severe keratitis, in adult dry eye patients who have not improved despite treatment with tear substitutes. The primary study endpoint is treatment effectiveness, fro...

Purpose: Evaluation in routine clinical practice of the effectiveness, tolerability and safety of cyclosporine (CsA) eye drop emulsion in the treatment of adults with dry eye disease (DED) and severe keratitis who failed to respond to previous artificial tear treatments. Methods: Interim analysis (4 and 12 week data) from a European non-intervent...

Reflection-based topography systems use the cornea as a convex mirror and view the first Purkinje image. Keratometers use two pairs of images in perpendicular meridian at a diameter of about 3 mm and is a highly accurate measure of the central curvature of regular corneas. Photokeratoscopes view the reflected image of the black and white concentric...

Diseases of the lids and ocular surface can induce both focal and widespread changes in corneal shape, with primary and secondary effects. A lid lump compressing the central cornea causes central flattening, whereas one compressing the peripheral cornea will cause secondary central steepening.

Topography is useful for the fitting of contact lenses, particularly in irregular corneas and for rigid lenses. By identifying the curvature of the steepest and flattest areas of the cornea and generating a simulated fluorescein pattern, it can direct the selection of the initial back surface curvature to be tried, thereby reducing the number of tr...

The shape of the anterior corneal surface can be measured in terms of height or elevation, slope and radius of curvature. This can then be converted to corneal power using the refractive index of the cornea.

The cornea is aspheric and normally prolate: the central cornea is approximately spherical in front of the pupil and then flattens peripherally through the paracentral and peripheral zones towards the limbal zone, but asymmetrically in different meridia. The centre of the cornea can be defined geometrically (intersection of horizontal and vertical...

The raw image obtained by a topography device can be viewed to provide qualitative information about the corneal shape. However it is the analysis of the data and its subsequent display as a colour-coded contour map which adds considerable value to the investigation. Additional displays include cross sections and three-dimensional wire nets.

In primary corneal ectasias, noninflammatory stromal thinning causes the cornea to progressively protrude forwards. Secondary ectasia occurs as a result of thinning due to corneal surgery or inflammatory stromal melt. In both types, in the early stages, the classical clinical signs may be absent, so the diagnosis relies upon topographic findings al...

Modern cataract surgery aims not only to remove the cataract but to reduce the patient’s dependence upon spectacles postoperatively. In the eyes with regular corneas, this is best achieved using the keratometry measurements within the biometry device to calculate the strength of intraocular lens to use. However, in irregular corneas and following r...

Projection-based topography systems include those using slit photography, rasterstereography, laser interferometry or moiré interference. An image is projected onto the surface of the cornea in the same way as a slide is projected onto a screen and viewed directly. Some of these systems have the advantage of obtaining data from irregular and non-re...

All corneal refractive procedures correct myopia by flattening the central cornea and correct hyperopia by steepening it. In procedures removing tissue from the superficial or anterior cornea (e.g. keratectomy and excimer or femtosecond laser procedures), topography can underestimate the change in corneal power because the algorithms assume a norma...

Corneal topography may be affected by surgery to structures other than the cornea, although techniques usually aim to minimise this. In these cases, assessment of corneal shape can be useful in the investigation of otherwise unexplained visual loss and in the development of new techniques.

In patients undergoing corneal surgery, topography is useful in preoperative planning, intraoperative modification and postoperative monitoring and problem-solving. Myopia is addressed by corneal flattening, hyperopia by corneal steepening and regular astigmatism by differentially addressing perpendicular meridian. These changes may be achieved by...

The Scheimpflug principles enable the capture of focused images of objects that are not parallel to the camera and lens, such as a curved cornea. This is achieved by careful movement of the image and lens planes. In the Pentacam, this is achieved by rotation around a central axis and capture of 50 meridional pictures.

Transplantation of corneal tissue can have relatively little effect on corneal shape when the layers removed and replaced are thin but can have more profound effects when thicker or even full-thickness.

Stromal disease can directly cause focal steepening (e.g. stromal swelling) or flattening (e.g. stromal thinning), with a reverse effect on the immediately adjacent area as the curvature returns to normal.

Objective To investigate the effect of intraocular lens (IOL) glistenings on visual performance and evaluate a new glistenings grading methodology. Methods and Analysis Thirty-four patients (34 eyes) were recruited. Corrected distance visual acuity (CDVA), mesopic gap acuity (MGA), functional contrast sensitivity (FCS) and forward light scatter we...

Purpose: Corneal collagen cross‐linking (CXL) was introduced in 2003 and has gained popularity as an early treatment option for corneal ectasias such as keratoconus, pellucid marginal degeneration and post‐lasik corneal ectasia. CXL is the only known treatment modality for these conditions and is believed to slow underlying stromal degeneration, ha...

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

Purpose: To report a series of 4 cases (3 patients) with late stromal graft rejection 32 to 46 months after an uneventful deep anterior lamellar keratoplasty (DALK). Methods: Three patients (4 eyes), who had undergone an uneventful DALK for keratoconus (3 eyes) and infectious keratitis (1 eye) 32 to 46 months previously presented with a history...

Purposes: A literature review to describe the current diagnosis and management of Acanthamoeba keratitis. Results: Acanthamoeba is a ubiquitous protozoan: 8 species, 5 genotypic classes have been reported to cause keratitis. It is potentially a sight-threatening infection, and there is often a poor prognosis because of a significant delay in dia...

Pellucid marginal degeneration (PMD) is a rare progressive condition resulting in inferior corneal thinning and astigmatism. Alongside keratoconus and keratoglobus, it is considered one of non-inflammatory corneal ectasias. The focus of corneal thinning is greatest inferiorly resulting in diminished visual acuity and overall reduction in visual qua...

PurposeTo assess the long term impact of ptosis surgery on health-related quality-of-life using the Glasgow Benefit Inventory (GBI) patient-reported outcome measure.Patients and methodsA retrospective case note review was carried out on all patients who had undergone ptosis surgery (6 November 2008 to 5 December 2010) by one surgeon at Royal Bourne...

The authors report for the first time two cases of upper eyelid entropion secondary to neonatal conjunctivitis that resolved spontaneously following the insertion of a bandage contact lens. Previous reports advocate early surgical intervention to correct the eyelid abnormality and prevent any permanent corneal scarring and visual loss.

To assess the quality of information and readability of the top internet sites for age-related macular degeneration (AMD). An examination of the technical information provision, quality and readability of websites found during an internet search for 'age-related macular degeneration'. Setting Six internet search engines were used to find 26 unique...

Objective To assess the quality of information and readability of the top internet sites for age-related macular degeneration (AMD). Design An examination of the technical information provision, quality and readability of websites found during an internet search for ‘age-related macular degeneration’. Setting Six internet search engines were used...

Abstract Abstract: : Purpose: Report efficacy and safety of intravitreal triamcinolone acetate (ivit TA) in the treatment of refractory uveitic cystoid macular oedema (CME). Methods: Noncomparative (nonrandomized, noncontrolled) prospective interventional case series of 65 eyes of 54 patients with uveitis related CME resistant to a minimum of 2 per...

Objective: The dietary phytoestrogens genistein and daidzein have been shown to relax agonist-preconstricted arteries in vitro; the mechanisms of relaxation remain incompletely understood. This study aimed to determine whether the relaxation of phenylephrine (PE)-constricted rat aorta and main pulmonary artery by genistein and daidzein was endothel...